Copay Proposal for Some Drugs, Emergency Visits

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The Senate Committee on Budget and Fiscal Review last week approved a significantly scaled-down version of a copay proposal for Medi-Cal beneficiaries.

The Legislature last year passed a more extensive copay proposal that was projected to save $511 million in general fund dollars for the state. It called for $5 per physician visit and $50 for an emergency department visit . In February federal health care officials nixed that plan.

The current proposal would impose a copay of $3.10 for non-preferred drugs, with an exception for patients who receive those medications by mail, and a $15 copay for non-emergency use of the emergency room.

The state estimates savings of $25 million in general fund money from the proposed copays, according to Michael Cohen, chief deputy director of the Department of Finance.

“The May [budget] revision reflected the disappointing news that the federal government was not going to approve the vast majority of the copays,” Cohen said at the committee hearing on Thursday, “but what you have before you is the remaining copays that we do expect to get approval of.”

Ross Brown, a Medi-Cal analyst at the Legislative Analyst’s Office, said CMS still needs to approve the new proposal.

“Those conversations are going on between the administration and CMS,” Brown said. “I think it’s certainly fair to say that the likelihood of approving this new proposal is much greater than the previous one from last year. The degree of likelihood, though, is still uncertain.”

If CMS does agree to the plan, the state would implement it on Jan. 1, 2013.

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